Minimally Invasive Direct Coronary Artery Bypass (MIDCAB) is a minimally invasive approach to conventional Coronary Artery Bypass Graft (CABG) surgery. MIDCAB is beating heart surgery, which means that stopping the heart (cardioplegia) is not necessary and a heart-lung machine is not required.

Unlike conventional surgery, which requires a 10"-12" incision to separate the sternum (sternotomy) and places the patient on the heart-lung machine, MIDCAB surgery can be performed through a 3"-5" incision placed between the ribs, or may be done with several small incisions.

MIDCAB surgery results in a faster recovery, fewer complications, and less pain after surgery. It is indicated for use when bypassing one or two coronary arteries. For bypassing three or more arteries, a conventional CABG is indicated.

How do surgeons perform surgery on a beating heart?

One of the greatest challenges in minimally invasive bypass surgery is the difficulty of suturing or "sewing" on a beating heart. If the surgeon chooses to operate on a beating heart, a stabilization system is used to steady only the portion of the heart where the surgeon is operating. A stabilization system avoids use of the heart-lung machine by making it possible for the surgeon to carefully work on the patient's heart while it continues to beat.

Potential Patient Benefits of Minimally Invasive Bypass Surgery

Minimally invasive bypass surgery is believed to have the same beneficial results as conventional bypass surgery--restoring adequate blood flow and normal delivery of oxygen and nutrients to the heart. Minimally invasive bypass surgery, however, has additional advantages related to the ability of the surgeon to work on a beating heart or through smaller incisions.

Shorter length of stay: Patients may experience less pain and may have a better ability to cough and breathe deeply after the operation so they are often discharged from the hospital in 2 to 3 days, compared to the typical 5 to 10 days for conventional CABG surgery.

Faster recovery: Avoidance of the heart-lung machine and the use of smaller incisions may reduce the risks of complications such as stroke and renal failure so that patients can return to their normal activities in 2 weeks rather than the typical 6 to 8 weeks with conventional surgery.

Less bleeding and blood trauma: Any time blood is removed from the body and put into the heart-lung machine, the patient must be put on anticlotting medications or given "blood products". Artificial circuits such as the heart-lung machine can also damage blood cells. These factors may affect the blood's ability to clot after surgery. Avoiding the heart-lung machine can alleviate this blood trauma.

Lower infection rate: A smaller incision means less exposure and handling of tissue, which may reduce the chances of infection.

Available to more patients:Some patients are poor candidates for traditional bypass surgery because their illness is too widespread, their heart is too weak, or because they will not accept blood products. Some patients are able to receive this life-saving surgery through minimally invasive techniques.

Less cost:The cost of minimally invasive cardiac surgery may be approximately 25% less than the cost of conventional surgery.